Provider Demographics
NPI:1033487327
Name:RED MAPLE MTU
Entity Type:Organization
Organization Name:RED MAPLE MTU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:951-358-5231
Mailing Address - Street 1:25100 RED MAPLE LN BLDG H
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-1120
Mailing Address - Country:US
Mailing Address - Phone:951-826-4620
Mailing Address - Fax:
Practice Address - Street 1:25100 RED MAPLE LN BLDG H
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-1120
Practice Address - Country:US
Practice Address - Phone:951-826-4620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare